A sewing needle in the liver. (Case Report).

Abstract

An 85-year-old woman with Alzheimer's dementia was hospitalized because of prolonged fever, breathlessness, and generalized pain. Blood analysis showed an elevated erythrocyte sedimentation rate, and temporal artery biopsy showed giant cell arteritis. Prednisone therapy was instituted, and the patient's condition partially improved. Incidentally, abdominal radiographs revealed a sewing needle in the right upper quadrant, and computed tomography (CT) showed that the needle was lodged in the liver parenchyma.

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Demented adults and children frequently swallow foreign bodies, which usually pass through the gastrointestinal tract uneventfully. Nevertheless, silent gastrointestinal perforation and migration of the foreign body throughout the abdominal cavity may also occur, illustrating that there are no insurmountable barriers in the pathways of foreign bodies. (1-3) We describe a demented patient who had prolonged fever and who was incidentally found to have a sewing needle in her liver. Presumably, she had inadvertently swallowed the foreign body before.

Accepted February 26, 2002.

References

(1.) de la Vega M, Rivera JC, Ruiz L, Suarez S. A fish bone in thc liver. Lancet 2001;358:982.

(2.) John KD, Segal I, Saadia R. Perforation of the gastro-intestinal tract by a foreign body: A case report. S Afr J Surg 1996;34:78-80.

(3.) Crankson SJ. Hepatic foreign body in a child. Pediatr Surg Int 1997;12: 426-427.

RELATED ARTICLE: Key Points

* Older adult patients with dementia may swallow foreign bodies, which usually pass through the gastrointestinal tract uneventfully.

* Silent gastrointestinal perforation and migration of foreign bodies throughout the abdominal cavity may occur in these patients.

Case Report

An 85-year-old woman with Alzheimer's dementia was admitted because of a 4-week history of fever, breathlessness, and generalized pain. Her medical history also included a left hip fracture. On examination, the patient was apathetic, disoriented, and febrile. The temporal arteries appeared normal. The abdomen was tender to palpation, but there were no signs of peritoneal irritation. Blood analysis showed erythrocyte sedimentation rate of 120 mm/h, mild normocytic anemia, slightly increased white blood cell count with left shift, and moderate elevation of alkaline phosphatase. Results of blood cultures and other microbiology studies were negative. Findings on electrocardiogram, echocardio gram, and chest radiograph were normal. Abdominal radiographs revealed a sewing needle in the right upper quadrant (Fig. I), and computed tomography showed that the needle was lodged in the liver parenchyma, just beneath its capsule (Fig. 2). A right temporal artery biopsy disclosed giant cell arteritis. High-dose prednisone therapy was instituted. During the next few days, the patient's fever disappeared and her general condition partially improved.

From the Department of Medicine, Hospital General of Castellon, Castellon, Spain.

Reprint requests to Bernardino Roca, MD, PhD, Catalunya, 33-A, 4, 12004 Castellon, Spain. Email: [e-mail]

Copyright (c) 2003 by The Southern Medical Association 0038-4348/03/9606-0616